Two years ago, infection control experts warned the confluence of influenza and COVID-19 could overrun hospitals in what they dubbed the “twin-demic.”
It never materialized because COVID-19 measures — practicing hand hygiene, masking and social distancing — kept the flu at bay.
This time is different.
Now experts are sounding the alarm about a “tri-demic” — a triple threat of respiratory illnesses that include lingering COVID-19, seasonal flu and RSV, which has been wreaking havoc among Colorado's children.
“In a sense, we’re already in it,” Dr. Connie Savor Price, Denver Health Medical Center’s chief medical officer, said. “We’ve had an unprecedented burden of hospitalizations due to RSV, primarily impacting our pediatric population.”
RSV — or Respiratory Syncytial Virus — is a common respiratory disease that typically causes cold-like symptoms from which most people recover within a week or two. But the virus can be serious for the very young and old, according to the Centers for Disease Control & Prevention.
In recent weeks, at least 80% of the pediatric beds at Denver Health have been occupied by RSV patients.
“From RSV, we do seem to be plateauing,” Price said. “We are seeing some sign of relief.”
That wasn’t the case last month.
Children’s Hospital Colorado, for example, redeployed patient care tents outside the emergency department of its Anschutz Campus location. The move came because of “record volumes of patients with respiratory illnesses,” Sarah Davis, a hospital spokesperson, said in an email to The Denver Gazette.
The patient care tent was first used in March 2020 in response to the COVID-19 pandemic.
The tents are still being used.
The number of Children’s Hospital patients seeking care — on average — was 30% higher than the busiest of days in a typical season, Davis said.
RSV with a vengeance
Children’s Hospital Colorado has seen some relief, but continues to monitor rising flu hospitalizations, said Dr. Kevin Carney, associate chief medical officer at Children’s Hospital Colorado.
“While our emergency department and inpatient volumes continue to be at very high levels and above any previous respiratory surge, we are finally starting to see some decreases in emergency department and inpatient bed demand,” Carney said in an update to staff Friday.
The data, however, paints a grim picture for this season.
In 2020, the county had 226 RSV hospitalizations, according to Denver Department of Public Health and Environment (DDPHE) data. Last year, Denver County saw 298 RSV hospitalizations. This year, there have been nearly 500 in the city and county.
“No one can argue that COVID-19 did not hit children very hard in the pandemic, but they’ve made up for it with RSV,” said Dr. Michelle Barron, senior director of infection prevention at UCHealth.
An estimated 58,000-80,000 children younger than 5 are hospitalized with RSV each year in the U.S.
But the concern is not just RSV.
UCHealth had 312 influenza admissions as of Nov. 29, compared to 35 cases in 2019.
Infants and children with weakened immune systems are among those at the greatest risk for severe illness with RSV, which includes Bronchiolitis and pneumonia.
Historically, RSV — like the flu — typically spreads in the fall and winter months.
Respiratory illnesses circulate year-round, although generally at lower levels when out of the winter season.
While RSV has largely impacted pediatric patients, COVID-19 and the flu have primarily affected hospitals' adult population.
COVID-19 hospitalizations are up this month over last, but those associated with the flu in the last two weeks have “begun to rise rapidly,” according to Denver Health officials.
Anticipating respiratory cases will continue to rise this winter, Denver Health has contracted more nursing and physician staff as well as shuffling units to open up more beds.
“We’ll flex them as needed,” Price said.
Limited resources
COVID-19 hospitalizations are nowhere near the peaks of previous waves that threatened to overwhelm local hospitals.
But hospitalizations are eking up.
As of Nov. 18, the single day hospital census for COVID-19 was 41, according to the latest DDPHE data available. On Oct. 28, there were 14 patients in local hospitals with COVID-19.
In a particularly bad season, any one of these respiratory illnesses could threaten to overwhelm local hospitals. The convergence of all three, though, is what has troubled local health officials.
And it’s not over yet.
UCHealth epidemiological modeling suggests hospitalizations from COVID-19 and flu have yet to peak. Modeling shows an increasing number of cases in the coming weeks.
With Denverites having all but vanquished COVID-19 mitigation efforts, the likelihood of a surge in respiratory illnesses is greater.
“Basic infection prevention works, when it’s done en masse,” said Barron of UCHealth.
Hospital beds and health care workers are a limited resource. By not getting vaccinated, masking or practicing good hygiene this respiratory season, individuals could contribute to the problem.
“This has implications even if you don’t get the flu,” Barron said. “We don’t want our healthcare systems so overburdened that they can’t do the care.”
Price, at Denver Health, agreed.
“Every single need to visit an ER department takes a hospital bed,” Price said. “At the end of the day, it doesn’t really matter for what.”
